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He Z, Wang P, Ye X. Novel endoscopic optical diagnostic technologies in medical trial research: recent advancements and future prospects. Biomed Eng Online 2021; 20:5. [PMID: 33407477 PMCID: PMC7789310 DOI: 10.1186/s12938-020-00845-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022] Open
Abstract
Novel endoscopic biophotonic diagnostic technologies have the potential to non-invasively detect the interior of a hollow organ or cavity of the human body with subcellular resolution or to obtain biochemical information about tissue in real time. With the capability to visualize or analyze the diagnostic target in vivo, these techniques gradually developed as potential candidates to challenge histopathology which remains the gold standard for diagnosis. Consequently, many innovative endoscopic diagnostic techniques have succeeded in detection, characterization, and confirmation: the three critical steps for routine endoscopic diagnosis. In this review, we mainly summarize researches on emerging endoscopic optical diagnostic techniques, with emphasis on recent advances. We also introduce the fundamental principles and the development of those techniques and compare their characteristics. Especially, we shed light on the merit of novel endoscopic imaging technologies in medical research. For example, hyperspectral imaging and Raman spectroscopy provide direct molecular information, while optical coherence tomography and multi-photo endomicroscopy offer a more extensive detection range and excellent spatial-temporal resolution. Furthermore, we summarize the unexplored application fields of these endoscopic optical techniques in major hospital departments for biomedical researchers. Finally, we provide a brief overview of the future perspectives, as well as bottlenecks of those endoscopic optical diagnostic technologies. We believe all these efforts will enrich the diagnostic toolbox for endoscopists, enhance diagnostic efficiency, and reduce the rate of missed diagnosis and misdiagnosis.
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Affiliation(s)
- Zhongyu He
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China
| | - Peng Wang
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China
| | - Xuesong Ye
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China.
- State Key Laboratory of CAD and CG, Zhejiang University, Hangzhou, 310058, People's Republic of China.
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Basij M, Yan Y, Alshahrani SS, Helmi H, Burton TK, Burmeister JW, Dominello MM, Winer IS, Mehrmohammadi M. Miniaturized phased-array ultrasound and photoacoustic endoscopic imaging system. PHOTOACOUSTICS 2019; 15:100139. [PMID: 31388487 PMCID: PMC6677929 DOI: 10.1016/j.pacs.2019.100139] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/10/2019] [Accepted: 06/17/2019] [Indexed: 05/04/2023]
Abstract
Visualization and detection of early-stage gynecological malignancies represents a challenge for imaging due to limiting factors including tissue accessibility, device ease of use, and accuracy of imaging modalities. In this work, we introduce a miniaturized phased-array ultrasound and photoacoustic endoscopic probe which is capable of providing structural, functional, and molecular data for the characterization of gynecologic disease. The proposed probe consists of a 64-element ultrasound phased-array transducer coupled to a fiber-optic light delivery system for co-registered ultrasound and photoacoustic imaging. The fabricated US and PA imaging endoscope's diameter is 7.5 mm, allowing for potential passage through the cervical canal and thus an intimate contact with gynecological tissues such as the cervical canal and uterus. The developed endoscopic probe was tested and characterized in a set of tissue-mimicking phantoms. US and PA resolutions were measured experimentally using 200 μm diameter wires, resulting in apparent axial and lateral diameters of 289 μm and 299 μm for US, and 308 μm and 378 μm for PA, respectively. The probe's abilities to operate in both discrete and integrated illumination/acquisition were tested in gelatin phantoms with embedded optical absorbers with the results demonstrating the ability to acquire volumetric dual-modal US and PA images.
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Affiliation(s)
- Maryam Basij
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Yan Yan
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | | | - Hamid Helmi
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - Timothy K. Burton
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Jay W. Burmeister
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - Michael M. Dominello
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - Ira S. Winer
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - Mohammad Mehrmohammadi
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
- Department of Electrical and Computer Engineering, Wayne State University, Detroit, MI, USA
- Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
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3
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Langhout GC, Kuhlmann KFD, Schreuder P, Bydlon T, Smeele LE, van den Brekel MWM, Sterenborg HJCM, Hendriks BHW, Ruers TJM. In vivo nerve identification in head and neck surgery using diffuse reflectance spectroscopy. Laryngoscope Investig Otolaryngol 2018; 3:349-355. [PMID: 30410988 PMCID: PMC6209613 DOI: 10.1002/lio2.174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 02/04/2023] Open
Abstract
Background Careful identification of nerves during head and neck surgery is essential to prevent nerve damage. Currently, nerves are identified based on anatomy and appearance, optionally combined with electromyography (EMG). In challenging cases, nerve damage is reported in up to 50%. Recently, optical techniques, like diffuse reflectance spectroscopy (DRS) and fluorescence spectroscopy (FS) show potential to improve nerve identification. Methods 212 intra‐operative DRS/FS measurements were performed. Small nerve branches (1–3 mm), on near‐nerve adipose tissue, muscle and subcutaneous fat were measured during 11 surgical procedures. Tissue identification was based on quantified concentrations of optical absorbers and scattering parameters. Results Clinically comprehensive parameters showed significant differences (<0.05) between the tissues. Classification using k‐Nearest Neighbor resulted in 100% sensitivity and a specificity of 83% (accuracy 91%), for the identification of nerve against surrounding tissues. Conclusions DRS/FS is a potentially useful intraoperative tool for identification of nerves from adjacent tissues. Level of Evidence Observational proof of principle study.
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Affiliation(s)
- Gerrit C Langhout
- Department of Surgery The Netherlands Cancer Institute-Antoni van Leeuwenhoek Amsterdam the Netherlands
| | - Koert F D Kuhlmann
- Department of Surgery The Netherlands Cancer Institute-Antoni van Leeuwenhoek Amsterdam the Netherlands
| | - Pim Schreuder
- Department of Head and Neck Oncology and Surgery The Netherlands Cancer Institute-Antoni van Leeuwenhoek Amsterdam the Netherlands
| | - Torre Bydlon
- In-Body Systems Department Philips Research Eindhoven the Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery The Netherlands Cancer Institute-Antoni van Leeuwenhoek Amsterdam the Netherlands.,Department of head and neck and Physics Academic Medical Center Amsterdam the Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery The Netherlands Cancer Institute-Antoni van Leeuwenhoek Amsterdam the Netherlands
| | - Henricus J C M Sterenborg
- Department of Surgery The Netherlands Cancer Institute-Antoni van Leeuwenhoek Amsterdam the Netherlands.,Department of head and neck and Physics Academic Medical Center Amsterdam the Netherlands
| | - Benno H W Hendriks
- In-Body Systems Department Philips Research Eindhoven the Netherlands.,Department of Biomechanical Engineering Delft University of Technology Delft the Netherlands
| | - Theo J M Ruers
- Department of Surgery The Netherlands Cancer Institute-Antoni van Leeuwenhoek Amsterdam the Netherlands.,Nanobiophysics Group, MIRA Institute University of Twente Enschede the Netherlands
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4
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Smartphone based optical spectrometer for diffusive reflectance spectroscopic measurement of hemoglobin. Sci Rep 2017; 7:12224. [PMID: 28939898 PMCID: PMC5610341 DOI: 10.1038/s41598-017-12482-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/07/2017] [Indexed: 11/25/2022] Open
Abstract
We report a miniature, visible to near infrared G-Fresnel spectrometer that contains a complete spectrograph system, including the detection hardware and connects with a smartphone through a microUSB port for operational control. The smartphone spectrometer is able to achieve a resolution of ~5 nm in a wavelength range from 400 nm to 1000 nm. We further developed a diffuse reflectance spectroscopy system using the smartphone spectrometer and demonstrated the capability of hemoglobin measurement. Proof of concept studies of tissue phantoms yielded a mean error of 9.2% on hemoglobin concentration measurement, comparable to that obtained with a commercial benchtop spectrometer. The smartphone G-Fresnel spectrometer and the diffuse reflectance spectroscopy system can potentially enable new point-of-care opportunities, such as cancer screening.
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Bogomolov A, Zabarylo U, Kirsanov D, Belikova V, Ageev V, Usenov I, Galyanin V, Minet O, Sakharova T, Danielyan G, Feliksberger E, Artyushenko V. Development and Testing of an LED-Based Near-Infrared Sensor for Human Kidney Tumor Diagnostics. SENSORS 2017; 17:s17081914. [PMID: 28825612 PMCID: PMC5579832 DOI: 10.3390/s17081914] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/07/2017] [Accepted: 08/15/2017] [Indexed: 11/29/2022]
Abstract
Optical spectroscopy is increasingly used for cancer diagnostics. Tumor detection feasibility in human kidney samples using mid- and near-infrared (NIR) spectroscopy, fluorescence spectroscopy, and Raman spectroscopy has been reported (Artyushenko et al., Spectral fiber sensors for cancer diagnostics in vitro. In Proceedings of the European Conference on Biomedical Optics, Munich, Germany, 21–25 June 2015). In the present work, a simplification of the NIR spectroscopic analysis for cancer diagnostics was studied. The conventional high-resolution NIR spectroscopic method of kidney tumor diagnostics was replaced by a compact optical sensing device constructively represented by a set of four light-emitting diodes (LEDs) at selected wavelengths and one detecting photodiode. Two sensor prototypes were tested using 14 in vitro clinical samples of 7 different patients. Statistical data evaluation using principal component analysis (PCA) and partial least-squares discriminant analysis (PLS-DA) confirmed the general applicability of the LED-based sensing approach to kidney tumor detection. An additional validation of the results was performed by means of sample permutation.
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Affiliation(s)
- Andrey Bogomolov
- Art Photonics GmbH, Rudower Chaussee 46, 12489 Berlin, Germany.
- Laboratory of Multivariate Analysis and Global Modeling, Samara State Technical University, Molodogvardeyskaya 244, 443100 Samara, Russia.
| | - Urszula Zabarylo
- Art Photonics GmbH, Rudower Chaussee 46, 12489 Berlin, Germany.
- Medical Physics & Optical Diagnostics, CC6 Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Dmitry Kirsanov
- Institute of Chemistry, St. Petersburg State University, Universitetskaya nab. 7/9, 199034 St. Petersburg, Russia.
| | - Valeria Belikova
- Laboratory of Multivariate Analysis and Global Modeling, Samara State Technical University, Molodogvardeyskaya 244, 443100 Samara, Russia.
| | - Vladimir Ageev
- Art Photonics GmbH, Rudower Chaussee 46, 12489 Berlin, Germany.
| | - Iskander Usenov
- Art Photonics GmbH, Rudower Chaussee 46, 12489 Berlin, Germany.
- Institute of Optics and Atomic Physics, Technical University of Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany.
| | - Vladislav Galyanin
- Laboratory of Multivariate Analysis and Global Modeling, Samara State Technical University, Molodogvardeyskaya 244, 443100 Samara, Russia.
| | - Olaf Minet
- Medical Physics & Optical Diagnostics, CC6 Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Tatiana Sakharova
- General Physics Institute of Russian Academy of Sciences, Vavilova 38, 119991 Moscow, Russia.
| | - Georgy Danielyan
- General Physics Institute of Russian Academy of Sciences, Vavilova 38, 119991 Moscow, Russia.
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Novikova T. Optical techniques for cervical neoplasia detection. BEILSTEIN JOURNAL OF NANOTECHNOLOGY 2017; 8:1844-1862. [PMID: 29046833 PMCID: PMC5629403 DOI: 10.3762/bjnano.8.186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/09/2017] [Indexed: 05/04/2023]
Abstract
This paper provides an overview of the current research in the field of optical techniques for cervical neoplasia detection and covers a wide range of the existing and emerging technologies. Using colposcopy, a visual inspection of the uterine cervix with a colposcope (a binocular microscope with 3- to 15-fold magnification), has proven to be an efficient approach for the detection of invasive cancer. Nevertheless, the development of a reliable and cost-effective technique for the identification of precancerous lesions, confined to the epithelium (cervical intraepithelial neoplasia) still remains a challenging problem. It is known that even at early stages the neoplastic transformations of cervical tissue induce complex changes and modify both structural and biochemical properties of tissues. The different methods, including spectroscopic (diffuse reflectance spectroscopy, induced fluorescence and autofluorescence spectroscopy, Raman spectroscopy) and imaging techniques (confocal microscopy, optical coherence tomography, Mueller matrix imaging polarimetry, photoacoustic imaging), probe different tissue properties that may serve as optical biomarkers for diagnosis. Both the advantages and drawbacks of these techniques for the diagnosis of cervical precancerous lesions are discussed and compared.
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Affiliation(s)
- Tatiana Novikova
- LPICM, CNRS, Ecole polytechnique, University Paris Saclay, Palaiseau, France
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Review: in vivo optical spectral tissue sensing-how to go from research to routine clinical application? Lasers Med Sci 2016; 32:711-719. [PMID: 27909918 DOI: 10.1007/s10103-016-2119-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
Innovations in optical spectroscopy have helped the technology reach a point where performance previously seen only in laboratory settings can be translated and tested in real-world applications. In the field of oncology, spectral tissue sensing (STS) by means of optical spectroscopy is considered to have major potential for improving diagnostics and optimizing treatment outcome. The concept has been investigated for more than two decades and yet spectral tissue sensing is not commonly employed in routine medical practice. It is therefore important to understand what is needed to translate technological advances and insights generated through basic scientific research in this field into clinical practice. The aim of the discussion presented here is not to provide a comprehensive review of all work published over the last decades but rather to highlight some of the challenges found in literature and encountered by our group in the quest to translate optical technologies into useful clinical tools. Furthermore, an outlook is proposed on how translational researchers could proceed to eventually have STS incorporated in the process of clinical decision-making.
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Spliethoff JW, Prevoo W, Meier MA, de Jong J, Klomp HM, Evers DJ, Sterenborg HJ, Lucassen GW, Hendriks BH, Ruers TJ. Real-time In Vivo Tissue Characterization with Diffuse Reflectance Spectroscopy during Transthoracic Lung Biopsy: A Clinical Feasibility Study. Clin Cancer Res 2015; 22:357-65. [DOI: 10.1158/1078-0432.ccr-15-0807] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 08/11/2015] [Indexed: 11/16/2022]
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Silva LD, Miranda A, Batalha R, Ferreira L, Santos M, Talhari S. High-risk human papillomavirus and cervical lesions among women living with HIV/AIDS in Brazilian Amazon, Brazil. Braz J Infect Dis 2015; 19:557-62. [PMID: 26260194 PMCID: PMC9425384 DOI: 10.1016/j.bjid.2015.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023] Open
Abstract
Objective The goal of this study was to determine the prevalence of human papillomavirus infection infection and cervical lesions and its associated factors among HIV infected women attending an AIDS clinic in Amazonas state, Brazil. Methods Cross-sectional study. Women attending an AIDS clinic in the city of Manaus between March and December 2011 for gynecological examination were invited to participate. Enrolled patients answered a standardized interview including demographical, behavioral, and clinical data. Additionally, patients underwent a gynecological evaluation with collection of cervical samples for cytological analysis and high-risk human papillomavirus infection hybrid capture. A blood sample was also obtained to determine CD4 and viral load levels. Results A total of 310 (82.9%) women participated in the study. High-risk human papillomavirus infection was detected in 191 (61.6%) cases; 24 (13.5%) had low-grade squamous intraepithelial lesion (SIL) and 4 (2.2%) high-grade SIL. No invasive cervical cancer was diagnosed. Median age was 32 (interquartile range (IQR): 27–38) years and median of education was 8.5 (IQR 4–11) years of schooling and 56.1% had a monthly income up to US$180. In multivariate analysis, being less than 30 years old [OR = 1.7 (95% CI: 1.2–2.4, p = 0.005)], high-grade SIL [OR = 6.5 (95% CI: 1.6–23.0, p = 0.009)], and CD4 counts <200 cells/mm3 [OR = 1.6 (95% CI: 1.2–2.0, p < 0.001)] were associated with high risk human papillomavirus infection infection. Conclusions In the present study high-risk human papillomavirus infection was frequent and it was associated to high-SIL. These results show the importance of gynecologic examinations in routine care and follow-up required by those who present with cervical lesions.
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Affiliation(s)
- Leila da Silva
- Fundação de Vigilância em Saúde do Amazonas, Manaus, AM, Brazil; Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil; Faculdade de Medicina, Universidade Nilton Lins, Manaus, AM, Brazil.
| | - Angélica Miranda
- Post Graduation Program in Tropical Medicine, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado/ Universidade do Estado do Amazonas, Manaus, AM, Brazil; Infectious Diseases Unit, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Rosieny Batalha
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Luiz Ferreira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil; Post Graduation Program in Tropical Medicine, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado/ Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Mayara Santos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
| | - Sinésio Talhari
- Post Graduation Program in Tropical Medicine, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado/ Universidade do Estado do Amazonas, Manaus, AM, Brazil
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Novel advancements in colposcopy: historical perspectives and a systematic review of future developments. J Low Genit Tract Dis 2015; 18:246-60. [PMID: 24633164 DOI: 10.1097/lgt.0b013e3182a72170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe novel innovations and techniques for the detection of high-grade dysplasia. MATERIALS AND METHODS Studies were identified through the PubMed database, spanning the last 10 years. The key words (["computerized colposcopy" or "digital colposcopy" or "spectroscopy" or "multispectral digital colposcopy" or "dynamic spectral imaging", or "electrical impedance spectroscopy" or "confocal endomicroscopy" or "confocal microscopy"or "optical coherence tomography"] and ["cervical dysplasia" or cervical precancer" or "cervix" or "cervical"]) were used. The inclusion criteria were published articles of original research referring to noncolposcopic evaluation of the cervix for the detection of cervical dysplasia. Only English-language articles from the past 10 years were included, in which the technologies were used in vivo, and sensitivities and specificities could be calculated. RESULTS The single author reviewed the articles for inclusion. Primary search of the database yielded 59 articles, and secondary cross-reference yielded 12 articles. Thirty-two articles met the inclusion criteria. CONCLUSIONS An instrument that globally assesses the cervix, such as computer-assisted colposcopy, optical spectroscopy, and dynamic spectral imaging, would provided the most comprehensive estimate of disease and is therefore best suited when treatment is preferred. Electrical impedance spectroscopy, confocal microscopy, and optical coherence tomography provide information at the cellular level to estimate histology and are therefore best suited when deferment of treatment is preferred. If a device is to eventually replace the colposcope, it will likely combine technologies to best meet the needs of the target population, and as such, no single instrument may prove to be universally appropriate. Analyses of false-positive rates, additional colposcopies and biopsies, cost, and absolute life-savings will be important when considering these technologies and are limited thus far.
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Boldrini NT, Freitas LB, Coutinho AR, Loureiro FZ, Spano LC, Miranda AE. High-grade cervical lesions among women attending a reference clinic in Brazil: associated factors and comparison among screening methods. PLoS One 2014; 9:e102169. [PMID: 25019210 PMCID: PMC4094527 DOI: 10.1371/journal.pone.0102169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 06/16/2014] [Indexed: 11/25/2022] Open
Abstract
Background Although screening for cervical cancer is recommended for women in most countries, the incidence of cervical cancer is greater in developing countries. Our goal was to determine the prevalence and factors associated with high-grade lesions/cervical cancer among women attending a reference clinic in Brazil and evaluate the correlation of histology with cytology, colposcopy and the high-risk HPV (HR-HPV) tests. Methods A cross-sectional study of women attending a colposcopy clinic was carried out. The patients were interviewed to collect demographic, epidemiological and clinical data. Specimens were collected for cervical cytology, Chlamydia trachomatis and HPV testing using the Hybrid Capture (HC) and PCR tests. Colposcopy was performed for all patients and biopsy for histology when cell abnormalities or cervical intraepithelial neoplasia (CIN) were present. Results A total of 291 women participated in the study. The median age was 38 years (DIQ: 30–48 years). The prevalence of histologically confirmed high-grade lesions/cervical cancer was 18.2% (95%, CI: 13.8%–22.6%), with 48 (16.5%) cases of CIN-2/CIN-3 and 5 (1.7%) cases of invasive carcinoma. In the final logistic regression model, for ages between 30 and 49 years old [OR = 4.4 (95%: 1.01–19.04), history of smoking [OR = 2.4 (95%, CI: 1.14–5.18)], practice of anal intercourse [OR = 2.4 (95%, CI: 1.10–5.03)] and having positive HC test for HR-HPV [OR = 11.23 (95%, CI: 4 0.79–26, 36)] remained independently associated with high-grade lesions/cervical cancer. A total of 64.7% of the cases CIN-3\Ca in situ were related to HPV-16. Non-oncogenic HPV were only found in CIN-1 biopsy results. Compared to histology, the sensitivity of cytology was 31.8%, the specificity 95.5%; the sensitivity of colposcopy for high-grade lesions/cervical cancer was 51.0%, specificity was 91.4% and the concordance with HPV testing was high. Conclusions The results confirm an association of HR-HPV with precursor lesions for cervical cancer. These data emphasize that cytological screening to detect precursor lesions is still important in some regions and that HR-HPV should be included for screening.
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Affiliation(s)
- Neide T. Boldrini
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
| | - Luciana B. Freitas
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
| | - Amanda R. Coutinho
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
| | - Flavia Z. Loureiro
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
| | - Liliana C. Spano
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
| | - Angélica E. Miranda
- Post-Graduate Program in Infectious Diseases, Federal University of Espirito Santo (Universidade Federal do Espírito Santo – UFES), Vitória-Espírito Santo (ES), Brazil
- * E-mail:
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Mourant JR, Marina OC, Hebert TM, Kaur G, Smith HO. Hemoglobin parameters from diffuse reflectance data. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:37004. [PMID: 24671524 PMCID: PMC3966635 DOI: 10.1117/1.jbo.19.3.037004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/11/2014] [Accepted: 02/18/2014] [Indexed: 05/20/2023]
Abstract
Tissue vasculature is altered when cancer develops. Consequently, noninvasive methods of monitoring blood vessel size, density, and oxygenation would be valuable. Simple spectroscopy employing fiber optic probes to measure backscattering can potentially determine hemoglobin parameters. However, heterogeneity of blood distribution, the dependence of the tissue-volume-sampled on scattering and absorption, and the potential compression of tissue all hinder the accurate determination of hemoglobin parameters. We address each of these issues. A simple derivation of a correction factor for the absorption coefficient, μa, is presented. This correction factor depends not only on the vessel size, as others have shown, but also on the density of blood vessels. Monte Carlo simulations were used to determine the dependence of an effective pathlength of light through tissue which is parameterized as a ninth-order polynomial function of μa. The hemoglobin bands of backscattering spectra of cervical tissue are fit using these expressions to obtain effective blood vessel size and density, tissue hemoglobin concentration, and oxygenation. Hemoglobin concentration and vessel density were found to depend on the pressure applied during in vivo acquisition of the spectra. It is also shown that determined vessel size depends on the blood hemoglobin concentration used.
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Affiliation(s)
- Judith R. Mourant
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, P.O. Box 1663, MS M888, New Mexico 87544
- Address all correspondence to: Judith R. Mourant, E-mail:
| | - Oana C. Marina
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, P.O. Box 1663, MS M888, New Mexico 87544
| | - Tiffany M. Hebert
- Jack D. Weiler Hospital, 1825 Eastchester Road, Room 3-37, Bronx, New York 10461
| | - Gurpreet Kaur
- Einstein Cancer Center, Department of Obstetrics and Gynecology and Women’s Health, 1695 Eastchester Road, Bronx, New York 10461
| | - Harriet O. Smith
- Einstein Cancer Center, Department of Obstetrics and Gynecology and Women’s Health, 1695 Eastchester Road, Bronx, New York 10461
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Hu F, Vishwanath K, Lo J, Erkanli A, Mulvey C, Lee WT, Ramanujam N. Rapid determination of oxygen saturation and vascularity for cancer detection. PLoS One 2013; 8:e82977. [PMID: 24358243 PMCID: PMC3865147 DOI: 10.1371/journal.pone.0082977] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 11/01/2013] [Indexed: 01/22/2023] Open
Abstract
A rapid heuristic ratiometric analysis for estimating tissue hemoglobin concentration and oxygen saturation from measured tissue diffuse reflectance spectra is presented. The analysis was validated in tissue-mimicking phantoms and applied to clinical measurements in head and neck, cervical and breast tissues. The analysis works in two steps. First, a linear equation that translates the ratio of the diffuse reflectance at 584 nm and 545 nm to estimate the tissue hemoglobin concentration using a Monte Carlo-based lookup table was developed. This equation is independent of tissue scattering and oxygen saturation. Second, the oxygen saturation was estimated using non-linear logistic equations that translate the ratio of the diffuse reflectance spectra at 539 nm to 545 nm into the tissue oxygen saturation. Correlations coefficients of 0.89 (0.86), 0.77 (0.71) and 0.69 (0.43) were obtained for the tissue hemoglobin concentration (oxygen saturation) values extracted using the full spectral Monte Carlo and the ratiometric analysis, for clinical measurements in head and neck, breast and cervical tissues, respectively. The ratiometric analysis was more than 4000 times faster than the inverse Monte Carlo analysis for estimating tissue hemoglobin concentration and oxygen saturation in simulated phantom experiments. In addition, the discriminatory power of the two analyses was similar. These results show the potential of such empirical tools to rapidly estimate tissue hemoglobin in real-time spectral imaging applications.
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Affiliation(s)
- Fangyao Hu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Karthik Vishwanath
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Justin Lo
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Christine Mulvey
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
| | - Walter T. Lee
- Division of Otolaryngology–Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
- Section of Otolaryngology–Head and Neck Surgery, Veterans Administration Medical Center, Durham, North Carolina, United States of America
| | - Nimmi Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States of America
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14
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Leigh SY, Som M, Liu JTC. Method for assessing the reliability of molecular diagnostics based on multiplexed SERS-coded nanoparticles. PLoS One 2013; 8:e62084. [PMID: 23620806 PMCID: PMC3631148 DOI: 10.1371/journal.pone.0062084] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/17/2013] [Indexed: 11/18/2022] Open
Abstract
Surface-enhanced Raman scattering (SERS) nanoparticles have been engineered to generate unique fingerprint spectra and are potentially useful as bright contrast agents for molecular diagnostics. One promising strategy for biomedical diagnostics and imaging is to functionalize various particle types ("flavors"), each emitting a unique spectral signature, to target a large multiplexed panel of molecular biomarkers. While SERS particles emit narrow spectral features that allow them to be easily separable under ideal conditions, the presence of competing noise sources and background signals such as detector noise, laser background, and autofluorescence confounds the reliability of demultiplexing algorithms. Results obtained during time-constrained in vivo imaging experiments may not be reproducible or accurate. Therefore, our goal is to provide experimentalists with a metric that may be monitored to enforce a desired bound on accuracy within a user-defined confidence level. We have defined a spectral reliability index (SRI), based on the output of a direct classical least-squares (DCLS) demultiplexing routine, which provides a measure of the reliability of the computed nanoparticle concentrations and ratios. We present simulations and experiments to demonstrate the feasibility of this strategy, which can potentially be utilized for a range of instruments and biomedical applications involving multiplexed SERS nanoparticles.
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Affiliation(s)
- Steven Y. Leigh
- Stony Brook University (SUNY), Department of Biomedical Engineering, Stony Brook, New York, United States of America
| | - Madhura Som
- Stony Brook University (SUNY), Department of Biomedical Engineering, Stony Brook, New York, United States of America
| | - Jonathan T. C. Liu
- Stony Brook University (SUNY), Department of Biomedical Engineering, Stony Brook, New York, United States of America
- * E-mail:
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15
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Wade R, Spackman E, Corbett M, Walker S, Light K, Naik R, Sculpher M, Eastwood A. Adjunctive colposcopy technologies for examination of the uterine cervix--DySIS, LuViva Advanced Cervical Scan and Niris Imaging System: a systematic review and economic evaluation. Health Technol Assess 2013; 17:1-240, v-vi. [PMID: 23449335 PMCID: PMC4781255 DOI: 10.3310/hta17080] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Women in England (aged 25-64 years) are invited for cervical screening every 3-5 years to assess for cervical intraepithelial neoplasia (CIN) or cancer. CIN is a term describing abnormal changes in the cells of the cervix, ranging from CIN1 to CIN3, which is precancerous. Colposcopy is used to visualise the cervix. Three adjunctive colposcopy technologies for examination of the cervix have been included in this assessment: Dynamic Spectral Imaging System (DySIS), the LuViva Advanced Cervical Scan and the Niris Imaging System. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of adjunctive colposcopy technologies for examination of the uterine cervix for patients referred for colposcopy through the NHS Cervical Screening Programme. DATA SOURCES Sixteen electronic databases [Allied and Complementary Medicine Database (AMED), BIOSIS Previews, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Database of Abstracts of Reviews of Effects (DARE), EMBASE, Health Management Information Consortium (HMIC), Health Technology Assessment (HTA) database; Inspec, Inside Conferences, MEDLINE, NHS Economic Evaluation Database (NHS EED), PASCAL, Science Citation Index Expanded (SCIE) and Science Citation Index (SCI) - Conference Proceedings], and two clinical trial registries [ClinicalTrials.gov and Current Controlled Trials (CCT)] were searched to September-October 2011. REVIEW METHODS Studies comparing DySIS, LuViva or Niris with conventional colposcopy were sought; a narrative synthesis was undertaken. A decision-analytic model was developed, which measured outcomes in terms of quality-adjusted life-years (QALYs) and costs were evaluated from the perspective of the NHS and Personal Social Services with a time horizon of 50 years. RESULTS Six studies were included: two studies of DySIS, one study of LuViva and three studies of Niris. The DySIS studies were well reported and had a low risk of bias; they found higher sensitivity with DySIS (both the DySISmap alone and in combination with colposcopy) than colposcopy alone for identifying CIN2+ disease, although specificity was lower with DySIS. The studies of LuViva and Niris were poorly reported and had limitations, which indicated that their results were subject to a high risk of bias; the results of these studies cannot be considered reliable. The base-case cost-effectiveness analysis suggests that both DySIS treatment options are less costly and more effective than colposcopy alone in the overall weighted population; these results were robust to the ranges tested in the sensitivity analysis. DySISmap alone was more costly and more effective in several of the referral groups but the incremental cost-effectiveness ratio (ICER) was never higher than £1687 per QALY. DySIS plus colposcopy was less costly and more effective in all reasons for referral. Only indicative analyses were carried out on Niris and LuViva and no conclusions could be made on their cost-effectiveness. LIMITATIONS The assessment is limited by the available evidence on the new technologies, natural history of the disease area and current treatment patterns. CONCLUSIONS DySIS, particularly in combination with colposcopy, has higher sensitivity than colposcopy alone. There is no reliable evidence on the clinical effectiveness of LuViva and Niris. DySIS plus colposcopy appears to be less costly and more effective than both the DySISmap alone and colposcopy alone; these results were robust to the sensitivity analyses undertaken. Given the lack of reliable evidence on LuViva and Niris, no conclusions on their potential cost-effectiveness can be drawn. There is some uncertainty about how generalisable these findings will be to the population of women referred for colposcopy in the future, owing to the introduction of the human papillomavirus (HPV) triage test and uptake of the HPV vaccine.
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Affiliation(s)
- R Wade
- CRD/CHE Technology Assessment Group, Centre for Reviews and Dissemination, University of York, York, UK
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16
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Chang VTC, Merisier D, Yu B, Walmer DK, Ramanujam N. Towards a field-compatible optical spectroscopic device for cervical cancer screening in resource-limited settings: effects of calibration and pressure. OPTICS EXPRESS 2011; 19:17908-24. [PMID: 21935155 DOI: 10.1364/oe.19.017908] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Quantitative optical spectroscopy has the potential to provide an effective low cost, and portable solution for cervical pre-cancer screening in resource-limited communities. However, clinical studies to validate the use of this technology in resource-limited settings require low power consumption and good quality control that is minimally influenced by the operator or variable environmental conditions in the field. The goal of this study was to evaluate the effects of two sources of potential error: calibration and pressure on the extraction of absorption and scattering properties of normal cervical tissues in a resource-limited setting in Leogane, Haiti. Our results show that self-calibrated measurements improved scattering measurements through real-time correction of system drift, in addition to minimizing the time required for post-calibration. Variations in pressure (tested without the potential confounding effects of calibration error) caused local changes in vasculature and scatterer density that significantly impacted the tissue absorption and scattering properties Future spectroscopic systems intended for clinical use, particularly where operator training is not viable and environmental conditions unpredictable, should incorporate a real-time self-calibration channel and collect diffuse reflectance spectra at a consistent pressure to maximize data integrity.
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